Malaria in Uganda
Overview
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| Source: Frank Young/USAID and Ruth Buckley/USAID |
Malaria is the leading cause of illness and death in Uganda, accounting for 25-40% of all outpatient visits at healthcare facilities. Up to 20% of all hospital admissions and 15% of in-patient deaths are due to malaria. Fighting the parasitic disease is, therefore, one of Uganda and the U.S. Government's highest priorities.a The U.S. Agency for International Development (USAID) in conjunction with U.S. Department of Health and Human Services/Centers for Disease Control and Prevention (HHS/CDC) through the President's Malaria Initiative is committed to reducing the burden of malaria by helping Uganda develop the capacity to more effectively prevent and appropriately treat malaria.b These activities include insecticide treated bed net marketing, prevention programs that target children and pregnant women and ensuring appropriate treatment is available and accessible. In Uganda, the President's Malaria Initiative coordinates with the Ministry of Health, the National Malaria Control Program and several local and global partners including the Roll Back Malaria Partnership (RBM), the Global Fund to Fight AIDS, TB and Malaria (GFATM), the UK International Development Agency (DFID) and the World Bank.
Malaria in Uganda
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The Uganda Ministry of Health (MOH) reports that "the risk of malaria infection exists in most of the 45 districts in the country. Over 90% of the population live in highly endemic areas with perennial transmission while the remaining 10% live in low transmission areas which are prone to malaria epidemics. Children are the common victims of malaria, with mortality rates being highest among those five years and younger."c The majority of malaria in Uganda is caused by the malaria parasite Plasmodium falciparum, and the principal vectors include Anopheles gambiae s.l. and Anopheles funestus.d Uganda, like many countries in the region, has reported Chloroquine and Sulfadoxine-pyrimethamine (SP) resistance to Plasmodium falciparum and has now adopted artemisinin-based combination therapy in their antimalarial treatment policy, as of 2004.e
Uganda Assessment Results
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| Source: Frank Young/USAID and Ruth Buckley/USAID | |
The Uganda National Malaria Strategic Plan and the Health Sector Strategic Plan II prioritize two main areas of intervention; i) Improving case management of clinical malaria through highly effective, artemisinin-based combination therapy delivered at health facilities as well as at the community/household level through home-based management of fever; and ii) malaria prevention using a combination of insecticide treated nets (ITN), indoor residual spraying (IRS) and environmental management (where feasible). This approach is complemented by prevention and treatment of malaria in pregnancy, forecasting and prevention of malaria epidemics, and sound monitoring & evaluation of implementation and impact. Key achievements:
- Uganda has been instrumental in developing models of distributing ITN vouchers to pregnant women in rural areas through antenatal care services;
- USAID and HHS/CDC support has been instrumental in scaling up both revised treatment policy and intermittent preventive treatment (IPT) in pregnancy;
- USAID and HHS/CDC has developed innovative programming to coordinate the public and private sectors in using similar prepackaging of antimalarial drugs for better compliance.
The President's Malaria Initiative
In June 2005, President Bush announced a significant increase in resources from the US Government in order to fight Malaria. This new groundbreaking initiative challenges other countries, partners, donors and foundations to also commit to combating this disease significantly in sub-Saharan Africa each year over the next five years. To launch this initiative, the United States will significantly expand resources for malaria in Angola, Tanzania and Uganda beginning in 2006, and will expand to at least four more highly endemic African countries in 2007, and at least five more in 2008. By 2010, the U.S. Government will provide an additional $500 million per year for malaria prevention and treatment. The goal of the President's Malaria Initiative is to reduce malaria deaths by 50 percent in each of the target countries after three years of full implementation. This effort will eventually cover more than 175 million people in 15 or more of the most affected African countries.b The PMI will assist Uganda to speed implementation of the Uganda National Malaria Strategic Plan and the Health Sector Strategic Plan II through additional support on distributing ITNs (particularly LLINs) in the north, as well as providing support to ensure the rapid, equitable, and effective distribution of nets procured via the global fund. The PMI will be putting particular efforts into the availability in rural areas of ACTs in both health facilities and through an effective home-based management of fever program.
Country Status (annual figure)
| Total Populationf | 24,810,250 |
| Population growth ratef | 3.4 |
| Life expectancy at birthf | 46 years |
| Per capita GDP in international $g | $1,038 |
| Total expenditure on health as % of GDPg | 7.4% |
| Per capita total expenditure on health (US$)g | $18 |
| Per capita government expenditure on health (US$)g | $5 |
Population at Risk for Malariaf
Endemic Risk: 90%
Epidemic Risk: 3%
Negligible Risk: 7%
Ugandan Districts Most Affectedh
All districts in Uganda are affected by malaria; however the highlands areas are most at risk for epidemics.
US Government Support for Malaria
USG support for the malaria response in Uganda is estimated to be: TBD
Implementing Partners in the President's Malaria Initiative
TBD
General Health and Development Indicators (DHS Data)
| Indicator | 1988 | 1995 | 2000/1 |
| Infant mortality rate (per 1,000 live births) | 98.3 | 81.3 | 88.3 |
| Under-five mortality rate (per 1,000 live births) | 177 | 147.4 | 151.5 |
| Percentage of women with no education | 37.8% | 30.6% | 21.9% |
| Total fertility rate (children per women) | 7.4 | 6.9 | 6.9 |
| Percentage of women who received antenatal care from a trained health professional prior to most recent live birth | 86.8% | -- | 92.4% |
| Percentage of children fully immunized | -- | 47.4% | 36.7% |
| Percentage of children with acute respiratory infection or fever taken to a health facility | -- | -- | 66.5% |
| Percentage of children underweight (-2 SD) | 23% | -- | 22.5% |
| Percent pregnant women attending an ANC at least once during pregnancy | -- | -- | 91.9% |
Indicators for the President's Malaria Initiative
The outcome and impact indicators listed below will be collected by the US President's Malaria Initiative and have been agreed upon by the RBM Partnership, of which the USG is a partner.
Malaria Impact Indicatorsa
| Key Impact Indicators | Baseline | Midterm | End of Initiative 2010 Target |
| Under-5 mortality rate (per 1000) (baseline 2000) | 151 | -- | -- |
| Proportion of deaths attributed to malaria - - among children under five in selected health facilitiesb (baseline 2000) | 42.9% | -- | -- |
| Under five case fatality fate in selected health facilities (baseline 2000) | 4.1%j | -- | -- |
| Proportion of morbidity inpatients attributed to malaria in under fives in selected health facilities. (baseline 2000) | 44.4%j | -- | -- |
The data in this table is DHS data unless otherwise noted.
2 Select information was not available; the Tanzania DHS Final Report 2004 will be available by the end of 2005.
3 Data source for future collection of this indicator will be determined.
Malaria Outcome Indicators2
| Key Outcome Indicators | Baseline | Midterm | End of Initiative 2010 Targetc |
| Proportion of under five with fever/malaria receiving correct treatment according to national guidelines within 24 hours of onset of fever. | -- | -- | 85% |
| Proportion of households with at least one ITN. (baseline 2001) | <2%j | -- | -- |
| Proportion of children < five sleeping under a mosquito net the previous night. (baseline 2000) | 7.3% | -- | -- |
| Proportion of children <5 sleeping under an ITN the previous night. (baseline 2000) | 3.2% | -- | 85% |
| Proportion of pregnant women sleeping under a mosquito net the previous night. (baseline 2000) | 6.6% | -- | -- |
| Proportion of pregnant women sleeping under an ITN the previous night. (baseline 2000) | <1% | -- | 85% |
| Proportion of pregnant women receiving at least two doses of IPT.d | 33.8%a | -- | 85% |
| Proportion of health facilities surveyed with no stockout of nationally recommended antimalarial drugs continuously for one week during the last three months at the time of survey. | -- | -- | -- |
| Proportion of children under five with uncomplicated malaria correctly managed in health facilities.e | -- | -- | -- |
| Proportion of houses targeted for IRS successfully sprayed.f | -- | -- | -- |
The data in this table is DHS data unless otherwise noted.
2 Select information was not available; the Tanzania DHS Final Report 2004 will be available by the end of 2005.
4 These targets reflect the Abjua Targets to be met by 2005: http://rbm.who.int/docs/abuja_declaration_final.htm
5 Data on this indicator will be collected from sentinel sites.
6 The World Malaria Report 2005 states that the MOH reported in 2000 the number of households treated with indoor residual spraying (IRS) to be 6,105.
7The World Malaria Report 2005 states that the MOH reported in 2002 (for 2001) in 17 districts of Uganda that 33% of pregnant women received SP at least twice during an antenatal visit.
Uganda: Distribution of Endemic Malaria
This map was developed using MARA data available at: http://www.mara.org.za/. Malaria distribution model: Craig, M.H. et al. 1999. Parasitology Today 15: 105-111. Boundaries distributed by ESRI.
References
a USAID website Uganda Success Stories.
b USAID Infectious Disease information and the President's Malaria Initiative. USAID Uganda.
c The Uganda Ministry of Health (MOH) website Malaria Control and Prevention.
d Centers for Disease Control and Prevention (HHS/CDC).
e The World Malaria Report 2005, Map 5. Also access more information on artemisinin-based combination therapy (ACT).
f United Nation Population Division - 2000 World Population Prospects: Population Database: The 2002 Revision.
g WHO Statistical Information System (WHOSIS): Country Official Health Indicators.
j Ministry of Health - RBM Baseline Survey in Selected Districts (Apac, Kabale, Mubende, Tororo) in Uganda (2001), from the World Malaria Report 2005.
h The Africa Malaria Report, 2003. Additional information: IDS/Health Information Bulletin WHO/CDC.